HHS announced its approval to start the state health care exchange in New York, Kentucky and Washington, D.C. last Friday. So far, the agency has given its approval to eight states in total. Under the health care reform, the states must be ready for open enrollment by October 2013 and operational by January 2014.

The governors of Florida, Michigan and Ohio said they would not set up health insurance exchanges on their own under the Affordable Care Act but indicated they might be willing to work with HHS on federally managed exchanges. The governors of Wisconsin and Georgia said they would not partner with HHS on exchanges, and the incoming governor of Indiana has indicated he also would not support a state-run exchange.

States have until Nov. 16 to tell HHS how they will meet requirements for health insurance exchanges or risk having the federal government run their exchanges for them. Federally run exchanges will accept all insurers that meet essential benefit requirements, the HHS guidance says.